Homestead Food Production and Maternal and Child Dietary Diversity in Nepal: Variations in Associations by Season and Agroecological Zone Bishnu Dulal, Gary Mundy, Rojee Suwal, Pooja Pandey Rana and Kenda Cunningham 12 July, 2017, NIL Conference
Background: Agriculture, Nutrition and Diets in Nepal Under-nutrition reducing but the prevalence : stunting, wasting, low BMI, and anemia remains high Issue: Diets lack diversity and micronutrient quality- mostly poor, DAG households Agriculture source of food but how agriculture contributes to nutrition-limited evidence/work Linking HFP and nutrition growing but study findings vary-bangladesh, Nepal, Africa No studies assessed effects of HFP on MDD along with seasonal variation
Background: Suaahara A large scale multi-sectoral integrated nutrition program (2016-2021) funded by USAID to address care, health and foodmajor determinants of undernutrition in 40 districts of Nepal Household food production: Vegetable gardening for Plant source micro nutrients (vit, minerals) to poultry rearing for Animal source foods (ASF): EHFP integrated with BCC, health, wash and nutrition education
Suaahara II CROSS CUTTING THEMES Improve the nutrition al status of women and children <5 years Improved Household Nutrition and Health Behaviors Increased Use of Quality Nutrition and Health Services by Women and Children Improved Access to Diverse and Nutrient-Rich Foods by Women and Children Accelerated Roll-Out of Multisector Nutrition Plan through Strengthened Local Governance Public Private Partnerships (PPPs) Gender Equality and Social Inclusion (GESI) Innovative Grants Program (IGP) Emergency Preparedness and Response Plan (ERPP) Monitoring Evaluation and Learning
Study aim and primary explanatory and outcome variables To examine associations between degree of HFP participation and dietary diversity among mothers and children under 2 years and also variations in these associations by season and agroecological zone (mountains, and terai) HFP participation: received veg seeds received chicks received technical support participated in HFP training participated in HFP beneficiary groups Dietary diversity Child: 7 food groups Women: 10 food groups (WDDS)
Study design and methodology Household seasonal monitoring survey: 2929 program beneficiaries interviewed from three corresponding agricultural seasons; dry-rainy-winter(2014-15) Analysis limited in the rainy and winter season to maintain consistency across the seasons: Rainy (N=1090) Nov. 2014 Winter (N=1011) April 2015 stratified multistage cluster sampling Systematic sampling techniques: HHs Data analysis: Descriptive statistics; bivariate and multivariable analyses were done to examine the relationship between participation in EHFP and maternal and child dietary diversity and variations by season and AEZ.
Results: Maternal dietary diversity Food Groups (%) Moutain (N=821) Rainy Terai (N=736) Mountain (N=273) Winter Terai (N=278) Starchy staples 100.0 100.0 99.0 100.0 Beans and peas 99.0 99.6 97.6 99.3 Nuts and seeds 21.6 24.2 4.2 20.1 Eggs 44.9 53.3 53.3 69.1 Dairy products 65.4 63.2 71.2 57.9 Flesh foods 71.3 73.4 73.8 76.6 Vitamin A rich dark green, leafy 93.9 93.8 88.8 90.3 vegetables Other vitamin A-rich fruits & 51.0 50.3 31.2 61.2 vegetables Other vegetables 83.8 84.0 81.0 99.3 Other fruits Mean dietary diversity score (1-10) 70.3 7.0 67.4 7.0 (1.7) 47.8 6.5 (1.6) 77.3 7.5 (1.5)
Results: Child dietary diversity 7 Food Groups Rainy Mountain Terai (N=545) (N=167) %/ %/ Mean (SD) Mean (SD) Winter Mountain Terai (N=307) (N=241) %/ Mean (SD) %/ Mean (SD) Starchy staples 98.9 98.8 98.0 100.0 Beans, peas, nuts and seeds 95.2 97.6 91.9 95.0 Eggs 52.7 56.3 52.4 71.8 Dairy products 65.9 62.3 77.2 59.8 Flesh foods 59.4 69.5 57.3 58.9 Vitamin A rich dark green, leafy vegetables, other vitamin A-rich fruits & vegetables 87.9 89.2 82.7 84.6 Other fruits and vegetables 84.4 86.8 69.4 97.9 Adequate dietary diversity (4 or more of 7 food groups) (%) Mean dietary diversity score (1-7) 91.9 5.4(1.3) 93.4 5.6(1.3) 87.0 5.3(1.6) 93.8 5.6(1.3)
Results: HFP participation and maternal dietary diversity Maternal Rainy Winter Mountain Terai Mountain Terai (N=819) (N=271) (N=734 (N=277) β P β P β P β P Participated in agriculture and livestock training 0.00-0.01 0.02 0.08 from Suaahara: ever Received chicks from Suaahara: ever 0.08 * -0.01 0.10 ** 0.05 Received seasonal seeds from Suaahara: in the previous season 0.00-0.02 0.07-0.01 Received technical support by Suaahara staff in the - 0.04 0.05 0.19 ** previous season 0.02 Participated in HFP beneficiary group meeting: in the 0.01 0.10 0.14 *** 0.19 ** previous season Homestead Food Production: composite score of participation in 5 key activities 0.03 0.05 0.12 ** 0.24 ** * We controlled for the following confounders: Household caste, household size, household number of children <5 years, household distance to nearest market, household member in foreign country as migrant labor, maternal age, maternal education, districts of the survey participants. P<0.05; ** P<0.01, and *** P<0.001
Results: HFP participation and child dietary diversity Child (6-23 months) Rainy Winter Mountain Terai Mountain Terai (N=359) (N=140) (N=278) (N=217) β P β P β P β P Participated in agriculture and livestock training from Suaahara: ever -0.05-0.09-0.10-0.01 Received chicks from Suaahara: ever 0.01-0.02 0.18 ** 0.12 Received seasonal seeds from Suaahara: in the previous season 0.00-0.06-0.08-0.07 Received technical support by Suaahara staff in the 0.08 0.06-0.31 *** previous season 0.07 Participated in HFP beneficiary group meeting: in the 0.07 0.09 0.06 0.31 *** previous season Homestead Food Production: composite score of participation in 5 key activities 0.05-0.04-0.06 0.35 *** We controlled for the following confounders: Household caste, household size, household number of children <5 years, household distance to nearest market, household member in foreign country as migrant labor, household distance to nearest market, household land size, maternal age, maternal education, child sex, districts of survey participants. P<0.05; ** P<0.01, and *** P<0.001
Discussions and conclusions HFP participation may play a more important dietary role in the winter season than in the rainy season for both mountain and terai districts A difference was seen by AEZ, but only during the winter season. Little to no difference was seen in dietary diversity between the mountains and the terai during the rainy season but the differences in the winter season were quite pronounced. Is it because of the dryness of the winter months, remoteness, limited markets in mountains? HFP programs, and similar agriculture/nutrition interventions, should be carefully designed, implemented, and evaluated to examine variation by context including place and time. A homogenous/blanket approach even within one country may not the best approach
Suaahara II would like to thank the Government of Nepal for their leadership. This presentation is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The content of this plan is produced by Helen Keller International, Suaahara II Program and do not necessarily reflect the views of USAID or the United States Government.